Provider Demographics
NPI:1588260848
Name:MOZULAY, KALYN (PA-C)
Entity type:Individual
Prefix:
First Name:KALYN
Middle Name:
Last Name:MOZULAY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 STANTON CHRISTIANA RD STE 202
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19713-2130
Mailing Address - Country:US
Mailing Address - Phone:302-384-7439
Mailing Address - Fax:302-384-7443
Practice Address - Street 1:620 STANTON CHRISTIANA RD STE 202
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713-2130
Practice Address - Country:US
Practice Address - Phone:302-384-7439
Practice Address - Fax:302-384-7443
Is Sole Proprietor?:No
Enumeration Date:2020-12-10
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC5-0011715363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant